吕坚伟+蒋晨+傅琦博+吕婷婷+李震东+邱丰

摘 要 目的：比较经耻骨后无张力尿道中段吊带术（retropubic tension free vaginal tape， TVT）和经闭孔无张力尿道中段吊带术（tension free vaginal tapeobturator， TVT-O）治疗女性压力性尿失禁的远期成功率和并发症。方法：回顾分析2000年1月—2005年8月确诊的压力性尿失禁女性患者219例，其中121例行TVT治疗，98例行TVT-O治疗。观察患者手术时间、术中出血量、膀胱损伤、尿潴留等手术相关并发症。通过电话和门诊复诊评估不同程度尿失禁患者1、5、10年的总体治愈率和满意度。结果：TVT组和TVT-O组术中出血量、手术时间及术后早期并发症的发生率差异均无统计学意义（P>0.05）。TVT组术后疼痛发生率低于TVT-O组（0.8%比7.0%，P<0.05）。术后1、5、10年，两组中度尿失禁患者治愈率差异无统计学意义（P>0.05）；但5年和10年后，TVT组重度尿失禁治愈率分别为81.7%和74.7%，TVT-O组分别为76.2%和63.1%，组间差异有统计学意义（P<0.05）。但TVT-O组术后10年的满意度高于TVT组。结论：从长远疗效来看，TVT是一种更安全、有效的治疗单纯女性压力性尿失禁的手术方式，尤其是针对重度尿失禁患者。

关键词 尿失禁 耻骨后无张力尿道中段吊带术 经闭孔无张力尿道中段吊带术 临床研究

中图分类号：R694+.54 文献标志码：A 文章编号：1006-1533（2016）14-0003-04

Long-term efficacy of TVT-O and TVT in the treatment of female stress urinary incontinence

LV Jianwei， JIANG Chen， FU Qibo， LV Tingting， LI Zhendong， QIU Feng

（Department of Urology， South Renji Hospital affiliated to Shanghai Jiao Tong University， Shanghai 201112， China）

ABSTRACT Objective： To compare the long-term efficacy and complication between retropubic tension free vaginal tape（TVT） and tension free vaginal tape obturator（TVT-O） in the treatment of female stress urinary incontinence（SUI）. Methods： A total of 219 SUI patients enrolled from January 2000 to August 2005 were retrospectively analyzed . Among them 121 patients underwent the TVT procedure and 98 patients underwent TVT-O procedure. The surgical related complications such as operation time， intraoperative blood loss， bladder injury and urinary retention were investigated. The patients were followed up for 1， 5 and 10 years and the overall cure rate and satisfaction of the patients with various degree of incontinence were assessed by call and outpatient interviews. Results： No significant difference was found in operation time， intraoperative bleeding and early complication between the two groups（ P>0.05） . The incidence of postoperative pain was lower in TVT group than in TVT-O group（0.8% vs 7.0%， P<0.05）. No significant difference was found in cure rate of patients with moderate incontinence in 1-， 5-and 10-year follow-up between the two groups（P>0.05）. But the cure rate of patients with severe urinary incontinence in TVT group was 81.7% and 74.7% in 5- and 10-year follow-up， respectively， which were higher than 76.2% a n d 63.1% in TVT-O group（P<0.05）. The patients in TVT group had higher satisfaction in comparison with those in TVT-O group in 10-year followup. Conclusion： TVT is a safer and more effective surgery for the treatment of female SUI， especially for those with severe urinary incontinence from long term efficacy.

KEW WORDS urinary incontinence； retropubic tension free vaginal tape； tension free vaginal tapeobturator； clinical study

尿道中段无张力吊带术（midurethral slings，MUS）是当前治疗女性压力性尿失禁（stress urinary incontinence，SUI）的经典微创术式，其中经耻骨后无张力尿道中段吊带术（retropubic tension free vaginal tape，TVT）和经闭孔无张力尿道中段吊带术（tension free vaginal tapeobturator，TVT-O）在临床上应用最为广泛，且临床效果也得到医师和患者的认可，但两者的远期疗效及并发症少见报道。本文分析我院采用TVT或TVT-O治疗SUI患者的长期疗效及不良反应。

1 资料与方法

1.1 一般资料

2000年1月—2005年8月我院收治SUI女性患者219例，其中行TVT治疗121例，年龄（56.32±9.78）岁，体质指数（BMI）25.29±3.2，曾行剖宫产45例，尿失禁问卷表简表（ICI-Q-SF）评分（13.28±15.83）分；行TVT-O治疗98例，年龄（57.03±10.08）岁，BMI 24.84±5.4，曾行剖宫产36例，ICIQ-SF评分（13.76±4.78）分。根据尿失禁的临床表现将患者分为中度尿失禁（腹压增加及起立活动时，有频繁尿失禁，需要佩戴尿垫生活）和重度尿失禁（起立活动或卧位体位变化时即有尿失禁，严重影响患者的生活及社交活动）。T……